From the B-Suite to the C-Suite: Improving collaboration with non-facility leadership to increase critical infrastructure investment

4 minutes

Earlier this year, I was talking with a Senior Facility Leader at a critical access hospital in the northwest. He informed me that he was being interviewed to potentially assume the CEO position at his hospital due to a pending retirement. My jaw dropped. Can you imagine such a thing? A “facility” person at the top of a healthcare organization? And there it was. I blurted out “You are going from the B-Suite to the C-Suite, Brother!” We laughed together. Regardless of the outcome of the interview, it’s a great opportunity for him to be considered, an obvious example of his talent, and an excellent way to frame up my thoughts on healthcare facility management.

Allow me to provide some perspective. In many organizations, facilities teams often live and work in the basements of their buildings. Hence the “B-Suite” analogy above. But in the context of this article, I want to use the “B-Suite” not as a physical location, and certainly not as a derogatory statement of rank or position in an organization, but contextually as a framework to outline the challenges we ALL have in communicating our infrastructure investment needs up to and with our non-facility leadership. This is especially challenging when we are competing against other departmental budgets (radiology, clinical engineering, IT, etc.) that are presumed to have a better ROI.

I was recently interviewed as part of an opportunity to join the advisory board of a large national healthcare engineering organization. I’d like to share portions of that interview here.

Q:  As the healthcare landscape continues to change, what are some of the common challenges facing the industry?

Based on my experience and obvious focus on our aging healthcare infrastructure, I understand the need for prioritized investment in the environment of care. This is not a new challenge, but one that I think requires more intense discussion and new perspectives in the coming years. As an example, I am expanding my definition of “prioritized investment” to include both operational and capital budgeting and forecasting as equal priorities, whereas historically, capital investment was my primary concern. As a common challenge for facility leaders, the perpetual pressure to reduce operational costs at some point is not sustainable.

In that regard, we are living in a perfect storm. Mandatory and Regulatory workload is minimally the same, if not increasing year over year. Yet, both capital and operational budgets are entirely discretionary at the administrative level and are increasingly difficult to defend. Deferred maintenance is increasing, new assets are difficult to procure, and in parallel, we are losing the most tenured and experienced staff members that maintain the assets already in place today. Aging infrastructure increase risk for our patients, employees, and communities, particularly in underserved regions, rural and urban alike, so we must chart a new course.

Q:  So, what can we do differently as facility leaders to increase C-Suite collaboration? 

Since 2016, I have been working with facility leaders across the country to document and defend infrastructure investment needs, and as part of my ongoing efforts, I would like to promote two specific initiatives that I believe can transform our profession.

First, we need to better document the effort associated with compliance and redefine it in financial terms. Much of the work we do is mandatory to maintain accreditation, yet our budgets are often seen as discretionary. Understanding the code is crucial, but communicating the costs is equally important. 

Second, we should expand and enhance the business acumen training in our facility management curriculum. In simple terms, linking critical infrastructure assets to the critical spaces and service lines they support can redefine the business value of the facility itself. As Warren Buffet likes to say, “Price is what you pay, value is what you get.” 

Managing a facility is different than maintaining a facility. Simple words in concept but said here as a means of making a clear statement. Planned, proactive replacement of critical assets (like an Air Handler that serves an operating room) is a much better alternative than a more expensive and dangerous “run to fail” strategy, which is much more costly in the end. No matter how you slice it, aging infrastructure increases risk. 


As an industry, we have historically underinvested in our infrastructure. It’s a fact. And for many organizations, the financial challenges imposed by the pandemic have, and will likely continue to exacerbate that problem for years to come. But in parallel, we are also being asked to harden our facilities against natural disasters, reduce our carbon footprint and reimagine the role of the facility itself in the future of healthcare, all of which require investment. 

So how do we reconcile these otherwise contradictory goals?  Only through the collaborative development of an objective business plan that can be supported and executed at all levels of the organization. Annual budgets must give way to 3, 5 or even 10-year strategic infrastructure plans, and the entire leadership team must be invested in the consistent execution of those plans. Quoting Yogi Berra, “If you don’t know where you are going, you’ll end up someplace else.” 

Simply put, there is a false narrative that money spent on infrastructure has no return. We just need to tell our story in a different way. All the way from the B-Suite to the C-Suite!